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‘STROKE’ October 2010. Dr Amer Jafar. Ethnicity and recurrence of stroke. Population-based study Compared poststroke recurrence and survival in Mexican Americans (MAs) and non-Hispanic whites (NHWs) with atrial fibrillation

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ethnicity and recurrence of stroke
Ethnicity and recurrence of stroke

Population-based study

Comparedpoststroke recurrence and survival in Mexican Americans (MAs)and non-Hispanic whites (NHWs) with atrial fibrillation

Recurrent strokeand all-cause mortality were compared by ethnicity with survivalanalysis methods.

slide3

MAs with atrial fibrillation have a higherstroke recurrence risk and more severe recurrences than do NHWsbut no difference in all-cause mortality

Aggressive strokeprevention measures focused on MAs are warranted

von willebrand factor levels and stroke
von Willebrand Factor Levels and Stroke

The aimof this study was to determine if von Willebrand factor levelsare associated with the risk of stroke

The study was part of the Rotterdam Study, a largepopulation-based cohort study among subjects aged 55 years

During an average follow-up time of 5.0 years,290 first-ever strokes occurred, of which 197 were classifiedas ischaemic

slide5

The risk of stroke increased with increasing vonWillebrand factor levels

The association was also present in subjectswithout atrial fibrillation and did not differ between sexes

The study concluded that: High von Willebrand factor levels are associatedwith stroke risk in the general population

mri for tia
MRI FOR TIA

Aiming to assess how frequentlyMRI/DWI was performed for TIA patients and ascertained the proportionof clinically defined TIA patients who had ischaemic lesionson DWI

All clinically defined TIA cases among residentsof a 5-county region around Cincinnati who presented to emergencydepartments were identified during 2005

slide7

Of 834 TIA events in 799 patients, 323 events(40%) had MRI/DWI performed

Patients with positive DWI were older and more likely to have atrial fibrillation

Conclusion:

Performing MRI/DWI on all clinically definedTIA patients in the community would reveal more cases of actualinfarction but would more than double current use

thrombolysis and hypothermia
Thrombolysis and hypothermia

The researchers studied the feasibility and safetyof hypothermia (neuroprotection) and thrombolysis after acute ischaemic stroke

Intravenous Thrombolysis Plus Hypothermia forAcute Treatment of Ischaemic Stroke (ICTuS-L) was a randomized,multicenter trial of hypothermia and intravenous tissue plasminogenactivator in patients treated within 6 hours after ischaemicstroke

slide9

In total, 59 patients were enrolled

This study demonstrates the feasibility andpreliminary safety of combining endovascular hypothermia afterstroke with intravenous thrombolysis

Pneumonia was more frequentafter hypothermia

A definitive efficacy trial is necessary to evaluate the efficacyof therapeutic hypothermia for acute stroke.

statins after i c haemorrhage
Statins after I/C haemorrhage

The research evaluated recent nationwide trends in discharge statintreatment after intracerebral haemorrhage hospitalization

The study used data from 25 673 patients with haemorrhagicstroke admitted to Get With Guidelines–Stroke participatinghospitals between January 1, 2005, and December 31, 2007

slide11

Discharge statin prescription among hospitalizedpatients with intracerebral haemorrhage has modestly risen overtime

The clinical implications of this care pattern among patientswith intracerebral haemorrhage require further study

the excite stroke trial
The EXCITE Stroke Trial

Comparing Early and Delayed Constraint-Induced Movement Therapy

the purpose of this study was tocompare functional improvements between stroke participantsrandomized to receive CIMT within 3 to 9 months(early group) to participants randomized on recruitment to receivethe identical intervention 15 to 21 months after stroke (delayedgroup).

slide13

The earlierCIMT group showed greater improvement than the delayed CIMTgroup

Early and delayed group comparison of scores 24 months after enrolment showed no statistically significantdifferences between groups

CIMT can be delivered to eligible patients3 to 9 months or 15 to 21 months after stroke. Both patientgroups achieved approximately the same level of significantarm motor function 24 months after enrolment

stroke and the weekend effect
Stroke and the weekend effect

The Nationwide Inpatient Sample 2002 to 2007 wassearched for all emergency room admissions for stroke in University of Florida

There were 599 087 emergency room admissions forischaemic stroke: 159 906 weekend admissions and 439 181 weekdayadmissions

slide15

The study concluded that: There is a slight stroke weekend effect onthrombolytic use, total hospital charges, and length of stay,but no difference in in-hospital mortality or discharge disposition.

carotid bruit
Carotid Bruit

The authors investigated whetherthe presence of a carotid bruit is associated with increasedrisk for transient ischaemic attack, stroke, or death by stroke(stroke death)

The study included 28 prospective cohort articles thatfollowed a total of 17 913 patients

Conclusion: The presence of a carotid bruit may increasethe risk of cerebrovascular disease.